Sunday, November 30, 2014

Day 30 - At Last

There's always a little bit of a letdown at the end of the NaBloPoMo (national blog posting month) even though it's a bit of a blessing as well, because writing on a daily basis is hard.  I'm a bit of a perfectionist so I always overthink my blog posts... will they like it...?  will they get it...?  will they like me...?  will anyone even read what I've written...?

I try.  I think we all do.  Bloggers feel as though they have something important to share with the world, and it's tough putting ourselves out there on a daily basis for a month.  Given that I'm a bi-monthly poster at best, it seriously takes a little out of me whenever I post.  Of course, I've written before that in some ways this is just a means to expressing the creative side of me given the high stress environment I find myself in most days.  But, still, who doesn't want to think that they're the greatest writer since Douglas Adams?

Anyway, tonight I bid you adieu for this year.... it's been quite the road as we've covered cases in the ED, the current state of affairs in healthcare, current events, my uncle's birthday, my dog's birthday, suicide, dancing it out, and of course Mexican telenovelas.  Thank you for joining me again this year for this little adventure.  I hope you'll stay throughout the course of the year for my random musings as this next year promises to be an exciting one with almost monthly trips planned along with several long journeys in the works...

Thank you!!


Saturday, November 29, 2014

Day 29 - Dixie's Third Birthday

Today is our Australian Shepherd Dixie's third birthday, and here is her video:


If you'd like to see how she's grown, here are her other videos:

Dixie's 1st birthday video

Dixie's 2nd birthday video

Don't judge me, I just have fur children...

Friday, November 28, 2014

Day 28 - Semi-Live Feed

I thought I would try an experiment today and put in events as they happen during my shift in the ED.  I don't have Twitter so I can't "live feed," but we'll see how this works out, so keep checking back as I will update this post as the day goes along and time permits.

0500 - Came on shift to get sign-out of 14 patient waiting for admission, discharge or consultants to see them.  This didn't include the 3 people who were on psych hold awaiting placement at local psych facilities.

0503 - The first ambulance of my day arrives bringing in someone with a "numb arm" because they fell asleep on it.  I send them to the lobby to await fast track.

0510 - Ambulance (AMB) - "my shoulder and hip hurt"

0530 - reviewed a chest x-ray (CXR) and diagnosed pneumonia in a toddler

0545 - picked up a patient that was triaged earlier with abdominal pain

0550 - AMB - spouse called because patient "didn't want to wake up."  Patient admits to "drinking a lot of alcohol last night."

0555 - AMB - elderly patient with shortness of breath

0630 - patient with shortness of breath has a large fluid collection on their lung, call for drainage; another patient from sign-out has a dislocated shoulder and the orthopedist asks for me to do procedural sedation so that it can be reduced - after a lot of propofol (aka milk of amnesia) the joint is put back in place and discharge orders are written; another psych patient has forms to be signed so that they can be transferred

0700 - getting busy; two car crash victims come in for evaluation; taking care of more of the sign-outs and getting them admitted/discharged/sent to psych, etc

0800 - AMB - "I'm dizzy and haven't been taking any of my medication"
         - AMB - "My heart is skipping beats, and I think my potassium is low"
         - AMB - "My finger is infected, I've had diarrhea and stomach cramps, I haven't picked up any of the medications I was prescribed for infection 2 days ago."
         - AMB - Assault
         - AMB - Psych nursing home patient with abnormal labs.

0830 - I got coffee on the way in... yeah, Dutch Brothers!... I just finally got breakfast... what I really needed was a Snickers bar since I was turning into quite the Diva
-------------------------------------------------------------
0900 - all Hell's broken loose... about 5 ambulances in a row and the psych patients are starting to get restless...

-------------------------------------------------------------
1000 - trying to clean up from the pile of EKG's and CT scan results that are inundating my work space... did I mention about 4 more ambulances arrived?

1015 - baby bell went off... another life comes into the world

------------------------------------------------------------
1100 - AMB - "My chest hurts and my esphophagus is in spasm."
         - AMB - "My back hurts because I was sitting at dinner and then coughed."
         - a "drunken bitch" that was a signout from overnight has finally sobered up enough to state that she doesn't remember what happened last night and wants to know why her ankle hurts so bad.  What she doesn't remember is stripping off all of her clothes and running naked down the middle of the street.  Happy Thanksgiving...!
        - AMB - "I've had the flu and my back hurts.  Oh, and I had neck pain with a fever..."
        - AMB - "I got a flu shot and now I think I have pneumonia"
        - AMB - Patient sent from nursing home with concern for weakness and they "need a feeding tube."
        - "My ear hurts"  I diagnosed a ruptured eardrum, and the patient wanted to know what I was going to do to "fix it."  I attempted to explain that they usually fix on their own, but she said that she couldn't hear and needed something done sooner.... yeah, um...

--------------------------------------------------------------
1200 - Help arrived, I don't have to pick up any new patients, however I had a pile waiting to be seen still
         - Concern for stroke, from Wisconsin, fellow cheesehead...
         - SVT and COPD admitted for both
         - HA with concern for head bleed because of prior history of head bleed
         - AMB - Concern for stroke with dementia, makes for a difficult physical exam
         - Pediatric asthma... parents, STOP SMOKING..!!
    
--------------------------------------------------------------
1300 - Trying to clean up from the day.  Labs to be reviewed.  Radiological studies to be followed up on.  They say on average an ED physician gets interrupted multiple times a minute.  I'm wrestling with managing over a dozen patients at once including the lingering sign-outs from the morning, especially one that is cursing at staff and telling everyone around them to F-off.  They're over 70 years old by the way...

1330 - Lunch while I chart!

1345 - Underage patient who smokes pot they "find around the house" here with concern that their "tongue is going to fall off."  They sit on the ambulance gurney holding onto their tongue so it doesn't.  I ask them to put their tongue back in their mouth.  They instantly realize they can and try to jump off the gurney saying "I'm all better I can go now!"  But, they can't because some of the other medications they "farmed" around the house are kicking in and they start to vomit.  I'll be signing this one out for sure.

---------------------------------------------------------------
1400 - I'm under the gun.  My scribe has left and I need to finish discharging/admitting/transitioning patients while I continue to be interrrupted and the other MD is getting overwhelmed by the waves of humanity.  Funny how fast things can change.  Yesterday at this time there were 10 patients on the board, no one in the lobby, and I was leaving my shift early... now there's a full board of 25+ patients along with 22 in the lobby, the longest of which has been waiting almost 3 hours...

----------------------------------------------------------------
1430 - I've got almost everyone admitted who's going to stay including the back pain because it just "hurts too much to walk" despite dosages of narcotics that would have me (and most people) unconscious for the next 36 hours.  Still waiting on call backs from admitting physicians.

----------------------------------------------------------------
1530 - The last of the admitting physicians have called back.  Everyone is signed out.  I am headed home... whew!











Thursday, November 27, 2014

Day 27 - Giving Thanks


Remember those who work to keep your family safe.
Remember those who work to keep your loved one healthy.
Remember those who work so that your
emergency doesn't turn into a tragedy.

Thankful for my colleagues, law enforcement officers
and first responders who shared this holiday
with me, doing what they do best.

Wednesday, November 26, 2014

Day 26 - Warning Labels


Most people know that they shouldn't drink and drive...
but they do.
Most people should know that they shouldn't use 
certain prescribed medications and drive...
but they do.

And we see the aftermath all the time in the
Emergency Department.

Or, I should say, all that remains from the aftermath;
because those that die immediately in that
rollover,
head on collision,
auto versus pedestrian,
or other accident
never make it to the ED.

We hear about them later in the news,
from family that come to the ED looking for their loved ones,
from the police officer, sheriff's officer, CHP officer, paramedic
or worse when they survive the accident, 
but then are pronounced in the ED because they are
too broken to be fixed.

But the DUI offender...?
They're rarely injured seriously.

There's a saying that there's a god that protects
drunks and small children, 
and never is that more truly realized than in the ED.

Sorry your ankle hurts "really bad,"
but that combination of methamphetamines and norcos
which caused you to cross the center line
should hold you over while you're being processed in jail
for the deaths of those grandparents who were just
traveling to see family.

I know your head hurts.
Bummer that the alcohol you used to wash down
the benzos you have for anxiety can't help that.
I'm sure the family of the child I'm flying out to a trauma center
understand that you needed to "just run out for some cigarettes."
I'm sure they're thinking of several ways to help you
stop smoking... permanently.

The nurses and I realize you think you need your
next dose of pain medications early for your broken wrist
by the endless pushing of the call button with your
good wrist which is, by the way, handcuffed to the bed,
but we're a little busy over here trying
to keep the teen you hit on their bicycle alive
because they've now got more tubes in them than a
1950's television, and the bleeding isn't stopping.
Would you like to make a donation?
Oh, no, sorry, the blood alcohol level is a little
too high, and the cocaine surge probably would be a bad thing.

Yes, back/tooth/arm/leg/stomach/neck pain can be very bad.
Here's your prescriptions for ibuprofen and norco.
Make sure you read the warning label, don't use alcohol
and don't drive or use heavy machinery...
any questions?







Tuesday, November 25, 2014

Day 25 - Text You Later...

Part of my evening wind-down routine is to get onto the computer and do what I call "link leaps of faith."  You know when you click a link that takes you to another link and so on, and so on...?  I was trying to think about what to write about and came across a link to an article posted by a woman who was sharing texts she and her hubby have sent to each other.  I liked the idea, so I went through my phone to find some of my own.

Now, you have to understand a couple of things.  One - my husband can't type or spell, so sometimes it's a challenge figuring out what he is trying to say, but I will translate for you.  Two - hubby and I have had a long distance relationship since we've met and even after we married.  I still continue to travel for weeks at a time, and sometimes he goes for get-aways with his friends, so lots of texts get sent while we're on the road, or he gives me updates on the goings-on at home.  I think some of the texts are self-explanatory, but I will help out on the others...

Conversation regarding another doctor's hobby...



We live in a very small town, so even a DQ is a big deal,
and DH has a sweet tooth...



I let my DH know how my day at work is going...


He celebrates when it's good...


or when I get really frustrated...




When I'm traveling, he let's me know
what's going on around the house...



Everything...



And the aftermath...



For some reason he was obsessed with a spoon
that he thought might have gotten "stolen by the caterer" or
accidentally thrown away.  When I found it in my travel lunch bag,
I taunted him with it...



After some early conflicts, he and my mother now
have a better relationship...



We travel often with her, and as I've said before,
she's the Slot Machine Queen...



Traveling with Momma...



She was coming to visit for Christmas last year, and
since we're Hispanic, she asked for some tamales ("Molly's")
which I asked my DH to pick up on the day she was going to arrive...



My DH, always thinking about food...



But the best texts show the attention to details...



Even when we're apart...



We always say good-night, ILY... 



















Monday, November 24, 2014

Day 24 - Breaking News


Grissom:  That's not what the evidence says.
Catherine: Well, maybe the evidence is wrong.
Grisson:  You can be wrong, I can be wrong, the evidence is just the evidence.

Like a lot of people, I was watching the live feed of the decision of the grand jury regarding an officer-involved shooting in Ferguson, Missouri.  Unlike a lot of people who only get their facts from mainstream media and social media, I expected that the grand jury being a group of intelligent people who when presented with the facts would find exactly what they did... that the police officer involved acted within the scope of his duties.

What I couldn't then fathom, were the politicians who stood up afterward and said how "disappointed" they were that justice wasn't served.  Really?  Did you not sit and listen to the evidence as presented by the prosecutor in the case?  No?  I guess you were too busy reviewing your cue cards.  I guess you were thinking about the great, "It's just like Selma" speech you had your advisors write, since I would think you were at least somewhat intelligent enough to understand that this case had nothing at all to do with the fact, but more how you wanted the public to perceive the facts.

So, let me sum it up for you:  A teen decides to rob a convenience store for some cigarillos.  We know from the tox screen that he was positive for marijuana, and cigarillos, especially Phillies, are known to be favorites for making blunts.



He assaults the cashier during the robbery.  He and his friend (who by the way, gave the most unintelligible and laughable interview about the case) then walk down the middle of the street in disregard for public safety (and their own I guess).  When the police officer asks them simply to get on the sidewalk "words are exchanged."  You can imagine what those might have been.

The police officer drives off, but then reverses the car when he realizes that the teen is carrying merchandise similar to that which was just reported stolen.  He then calls out to the teen and his friend.  Things get muddled as everything happened very quickly, but what can be discerned by the evidence is that the teen goes to the police officer's car and there is some kind of a struggle in which shots are fired.  The teen runs after getting hit in the hand.  The officer gets out of the car after calling for back-up.

At some point the teen stops running and turns around.  More shots are fired as the teen possibly starts coming back toward the officer without stopping.  When the teen stops, the shooting stops, and then starts again after the teen comes again toward the officer.  If you're shot in the back, blood spatter would show a different story than the one presented by the forensics team.  And three separate autopsies don't lie.  They corroborate the evidence.

Am I sad about the youth?  Not really.  He was 18.  Supposedly accepted and planning to go to "a technical college."  But he made several bad choices that resulted in his death, none of which had anything to do with the color of his skin:  he decided to rob a store, assaulted a cashier, walked down the middle of a busy street, and did not follow a police officer's instructions.  Shot up to this point?  No.

But wait, he tussled with the officer, had his thumb shot and ran.  Why didn't he just keep running?  Why did he turn around?  If he put his hands up, it would have been over, but he came toward the cop who then fired.  He stopped, the cop stopped, and again, put your hands up... but, he didn't.  And, that's why we're here today.  And, probably will be for the next several days as the media fuels the racist flames once more and politicians keep trying to compare what's happened to their ancestor's plight during the 1960's and the fight against segregation.

This is nothing like that.  This is just another story in the continuum that this current administration has kept on their agenda to promote separation and division in the country.  Take away color and this is just another punk kid who thought he was above the law and could do as he pleased.  But, you can't take away color because this kid probably thought he was protected by it;  as most of the protestors probably think they are now.  Because what cop in their right mind would go against them?  What white cop anyway...

Sunday, November 23, 2014

Day 23 - Be Still

Lake Roosevelt, 10/2009 vb

Be still and know that I am God - 
Psalm 46:10

Taking a day of rest before heading into the
holiday, and a straight week of work
leading to the end of the month
and the last week of NaBloPoMo...


Saturday, November 22, 2014

Day 22 - Saturday Night Dance Party


What would you tell your 20-something year old self
if you could go back in time..?

I'd tell me to stay in shape so I could continue
dancing like I used to then.

A shot and a beer since I was generally the DD,
and I could dance all night long.
Go to bed at 3, and be up at 8 to be to work at 
9 the following morning.

And, I LOVED to dance.
Still do.. in fact, my best friend commented
that dancing at my wedding was the funnest
time she'd had in a long time... 
because we love to dance...


So tonight, I thought I would share my
top 10 all time favorite dance songs...

10. Ice Ice, Baby - Vanilla Ice
9. Do You Love Me? - The Contours
8. Kiss Me - Stephen Duffy
7. Perfect Kiss - New Order
6. Mony Mony - Billy Idol
5. Just Can't Get Enough - Depeche Mode
4. Bizarre Long Triangle - New Order
3. Tainted Love - Soft Cell
2. Strangelove - Depeche Mode
1. Into the Groove - Madonna

Along with my top 10, 
if-I-were-20-I'd-be-shaking-my-thing-at-the-clubs songs, 
because I think I'll probably be 80 and still listening, 
and probably tapping my toes, 
to dance music...

10. I Know You Want Me (Calle Ocho) - Pitbull
9. Hey Na Na - Katie Herzig
8. Scream & Shout - will.i.am
7. Bailando - Enrique Iglesias
6. Low - Flo Rida
5. So What! - Sanchia
4. Sexy and I Know It - LMFAO
3. Jump - The Cube Guys & Luciana
2. I Like It - Enrique Iglesias
1. Work Bi*ch - Britney Spears


Also guaranteed to make me get out of my chair:
Oye Como Va - Celia Cruz
Church - T-Pain
Point of No Return - Expose
Mickey - Toni Basil
anything by Prince
dance songs by Madonna
the Knack, the Clash, the B-52's, Oingo Boingo,
Linkin Park, the Cure, Salt-n-Pepa
some Katy Perry
classic dance music from the 50's and 60's
think Tequila, Twist and Shout, Swing the Mood, Wooly Bully
and, don't even get me started on salsa and Latin music...!








Friday, November 21, 2014

Day 21 - What's Next?


I loved the TV show "The West Wing" for many reasons.
Today, one of them is for the line I posted:
"What's next?"

You see, I'm a person with a short attention span.
I need a little chaos in my life to function properly.
Some of my best studying in medical school
was in the ER.
I don't need white noise; 
I need heavy metal blasting, in your face, 
the walls are falling down around you noise.
And, I feel completely calm in the middle of it.

Going along with this, my DH comments that
I'm not myself unless I have the TV on,
with the computer on my lap, referencing my iPad
and occasionally glancing or texting on my phone,
all at the same time.


Which is probably why I have so many arts and crafts supplies
that I am planning an entire room dedicated to them.
Beading supplies will sit next to
quilting fabric which will be bordered by
scrap book papers and cutouts which will share shelf space with
paints and pencils and books about drawing alongside
sheet music and photography supplies and yarn and
and and...

I'm always looking for the "what's next...?"
and generally have several projects going on at the same time.
Now, for the first time in a while,
I actually have some free time to think about it...

What to do, what to do..?








Thursday, November 20, 2014

Day 20 - Moo...


Before you notice that I missed a day there,
just take a few moments to enjoy this pastoral scene
involving cows...

Nothing can be wrong with the world when
you're looking at a field of Happy Cows from California.
Given that I now live in "Cream City", this is my view
on my commute in and out of town.


Of course, the neighbors sometimes come over to
say "hello" when I am pulling out of my driveway.
"Moo, cow..."




Tuesday, November 18, 2014

Day 18 - When the Patient Comes Home


Back in June, I wrote about my DH
the hang glider.

I wrote about how I've taken care of friends of his who
have had to come to the ED because of various mishaps.
And, now my DH has suffered an injury as well.

No ED trip for him though.  We were vacationing in Oregon,
and while I took some time off to just think about things,
he spent time with his friend and went hang gliding...
... and then at the end of the flight, he came in for a 
hard landing.

He came back to the cottage barely able to move his right arm,
and I had to help him with his clothing.
For a few moments, I was back in doctor mode:
check pulses, check range of motion,
check for fractures, think about RICE:
Rest, Ice, Compression, Elevation.

We had some ibuprofen, so I gave him some of those.
Iced the injury.  Considered X-rays, but I didn't think they
were necessary.  Made him comfortable for the night.

Watching the video, and knowing what I know so far
about the aerodynamics of flight, I know it was a hard landing.
I'm glad he wasn't hurt much worse.

That was three weeks ago.
He still hurts.
And, I think there might have been a small 
avulsion fracture in his elbow.
It crunches when I range his arm,
and he has nerve pain.

At least it's not all black and blue like it was.
And, he doesn't hurt as much as he did,
but he still hurts, and he can't do all the things
around the house like he is used to.

It's been hard seeing him like this, but I keep checking on him,
wrapping his arm, trying to make him comfortable.

I'm just not used to playing doctor for more than
a couple of hours...  

Monday, November 17, 2014

Day 17 - Prompted


I couldn't think of anything specific to write about tonight, so I decided to see what the NaBloPoMo topic was.  Last year, close to this time, I wrote what I thought would be a post that would get a lot of comments.  A year later, close to a thousand reads on both my blog and on BlogHer and two comments...

You see, being an ED physician, we're on the front line of medical care.  We are the "gate keepers" to the hospital.  And, on occasion, we get very frustrated with what we see come into the emergency department.  We see the good, the bad and the ugly.  We see the best of people, and we see the worst that people can do to each other.  There are times when we wish for mandatory sterilization and the requirement of government permits to allow people to have children.  There are times when we wish we could enact frontier justice, but we can't... because we are bound by a higher oath to care for others.

Regardless, here's a link to the post I wrote.  Let's see if this time it garners a little more discussion.  Talk amoungst yourselves.

Weeping for the Future 

Sunday, November 16, 2014

Day 16 - Natural Foods


We're blessed to be able to live in a natural setting...


Twenty acres of lush ferns and pine trees...


And one of the first things we discovered were some edible mushrooms.


Chanterelles can be found along our upper ridgeline.


These beauties can be eaten after cooking in 
wine or butter which they absorb and which
enhances their flavor.


This year at our annual Wine and Mushroom Party,
I learned we also have bolete mushrooms...
I thought they just looked like big alien 
pancakes.


But supposedly they are also very tasty and prized,
and my guests had a great time finding both
chanterelles and boletes.

Not as many as in years past because of the lack of rain,
but at least more than the one or two that were found last year.

Next year I hope it will be an even better hunt...!
If you do go out hunting on your own,
make sure someone is checking what you pick, because
there are some look-alikes that will get you sick...
or worse...

Stay safe, my friends...!

Saturday, November 15, 2014

Friday, November 14, 2014

Day 14 - Just a Little Something I Threw Together


I love to eat, and what's more,
I love to cook...


From traditional foods that I learned to cook
watching my grandmother at the stove
as I was growing up...




To some fancier, more challenging fare...



It's nice to have a day to just relax and cook...
crank up the Salsa music and see what's in the fridge
that I can throw together...


Yeah, that's about right....
bon appétit!